In Overhaul of Hospital Rules, New York Slashes Interns' Hours

By HOWARD W. FRENCH

Published: July 3, 1989

Regulations that dramatically change the way hospital staffs in New York State operate took effect this weekend, sharply reducing the grueling working hours of medical interns and residents and greatly increasing their supervision by senior doctors.

Reversing the tradition of 100-hour workweeks and longer, the rules set explicit limits of 24-hour shifts and 80-hour weeks for most residents. They also modify the practice of thrusting residents quickly into positions of daunting responsibility.

The regulations are the first of their kind in the nation and are being closely watched by state officials around the country. The rules have been criticized by a hospital trade association as unwieldy and too costly. At hospitals throughout the state this weekend, medical staffs learned new routines. Mixed Medical Reaction

Most hospitals started a system called a ''night float.'' Instead of the 36-hour shifts that were a rite of passage for young doctors, residents will work shifts lasting between 12 and 24 hours.

At several hospitals in New York City, the new regulations drew a mixed reaction from interns, residents and supervisors. Some said the night float would reduce fatigue and improve patient care. Others said care might decline, because the shorter shifts would make it less likely that one doctor could handle a case continously.

They also expressed concern that the shorter shifts would hamper their learning experience.

Several residents at the Bellevue Hospital Center said yesterday that they would not feel comfortable handing their cases over to other residents, no matter how tired they were.

''I think this law really gets in the way of caring for patients,'' said Dr. Michael Kim, a third-year resident in trauma surgery who had just finished 24 hours in the emergency room. ''Say you're working all night and you've worked up three people for surgery and you want to operate. They say: 'No, your 12 hours are up. You've got to go home.'

''It's not just a job. You don't come to work for 12 hours and go home.''

Dr. Kildare I. Clarke, the associate medical director of Kings County Hospital in Brooklyn, said he supported the shorter hours because after a 36-hour shift it was difficult for residents to make subtle diagnoses.

''It's overwhelming,'' he said. ''Even with 12-hour shifts, people do get tired.''

Many residents agreed that the reduction in working hours and responsiblity would improve their personal lives, that they would be able to enjoy family life and leisure time, as they were unable to do in the past.

''People who are fellows say things like, 'In the days of the giants, we used to live in the hospital and didn't have people following us around to check on everything,' '' said Dr. Cathy Kirkland, a 30-year-old chief resident at the Presbyterian Hospital in Manhattan. ''But I think a lot of residents are actually relieved that we are no longer sanctioning the idea that they should know everything from day one.''

The regulations were devised a year ago by a commission of medical experts impaneled by the State Health Commissioner, David Axelrod. Influenced by Jury Report

The regulations grew out of a grand jury report into the death in 1984 of Libby Zion, the 18-year-old daughter of Sidney Zion, the author and journalist.

Miss Zion died while under the care of residents and interns working the late-night shift at New York Hospital in Manhattan. The grand jury did not file criminal charges but recommended sweeping changes in the supervision of young doctors.

By limiting the working hours of young doctors in training, closely monitoring their work and at the same time relieving them of many routine tasks, like drawing blood and starting intravenous procedures, the regulations are intended to improve patient care in hospitals throughout the state.

But the regulations have been embroiled in controversy. Although hospital officials have praised their intent, some have questioned their financial impact at a time of economic losses in the industry. Medical educators, meanwhile, have publicly worried that the regulation's rigid formulas could hamper learning by interns and residents. Two Lawsuits Pending

Even as the new rules, which are known as the 405 regulations, took effect on Saturday, two lawsuits cast clouds over their future. One was filed by the Hospital Association of New York State, which represents most of the state's private and nonprofit hospitals, and another by Blue Cross and Blue Shield. Each suit is challenging the state's plans for financing the new regulations.

Most of the state's approximately 150 teaching hospitals, which employ interns and residents, have spent the last several months tinkering with a variety of work schedules that would allow them to comply with the new rules.

Under the night float system that many hospitals are using, the residents take turns providing patient coverage overnight. In the morning, at the completion of their tours, they brief the residents coming on duty on the patients and their problems.